[hrb] Universal Health Coverage Bill 1t455s

Current Policy / Issues

UHC Provision

Roles of agencies Entitlements

Universal Health Coverage • Classify into public health and personal based interventions

• Classify into population-based and individual-based health interventions

• No clear delineation on ability with overlapping of financing and delivery functions

• DOH: finance population-based services, set standards, integrate a whole-of-society & whole-of-government approach • PhilHealth: finance all individual-based level services as a single, national purchaser • National and local governments: deliver population-based interventions • PhilHealth-contracted networks of public and private facilities: deliver individual-based interventions

Cost Coverage

Services Coverage

Population Coverage

Philippine Health Insurance Corporation • Population oversegmentized into 5 sectors leading to • Simplified hip into two: contributory (with capacity difficulty in capture and retention of hip to pay), and non-contributory (subsidized through tax • Poor continuity in informal sector due to revenues by the national government) voluntary basis • Eligibility through automatic inclusion to the National Health • Complex eligibility rules confusing to Security Program • Different benefit package eligibilities per member type, leading to confusion • Arbitrary selection and development of benefit packages • Insufficient and selective coverage for outpatient (only for indigents) • Non-coverage for emergency cases

• Uniform benefits for all • Prioritize using a fair, and transparent priority setting process guided by Health Technology Assessment (HTA). • Development of a single, comprehensive, primary care package (include medicines), for all • Creation of supplementary coverage by HMOs and private health insurance • Network-based licensing, contracting, & accreditation of facilities

• High, uncontrolled co-payment levels leading to high • Ensuring No Balance Billing (NBB) for the non-formal OOP for patients or ward issions and fixed co-payment for formal sector • Lack of regularly collected cost data to guide or private room accommodation payment rates • Mandate to regularly collect cost data from facilities

Health Human Resource

• Compensation for public health workers are not competitive versus the private sector • No clear guidelines on distribution of PhilHealth reimbursements for professional fees, leading to large variations • Insufficient number of plantilla items in public facilities, for both general practitioners, specialists, and allied health professionals • High cost of health professional education translating to barrier to needed level of production • Insufficient number of professionals entering into service for public facilities • Curriculum oriented towards tertiary care

Health Care Institutions

• Number of private beds overtaking number of public beds in government facilities limiting available beds for poor and near-poor • Arbitrary mushrooming of health care facilities which worsens equity of access • Partial or non-retention of income leading to health funds not reinvested in health • Different hospitals, different procedures

Information Systems

• Fragmented and irregularly updated surveillance and • Establishment and monitoring of disease registries health systems data • Establishment of an integrated health human resource • Manual, paper-based systems database • Mandating submission of encoded istrative, clinical and costing data by health care providers

Knowledge Generation

Department of Health • Competitive compensation, with those serving in GIDA areas receiving national salary rates plus additional s and allowances as necessary • Set-up explicit guidelines for distribution of PhilHealth reimbursements for professional fees to strategically complement salaries • Ensure that public funding for health professional education is available to deserving students • Mandatory return service for all publicly-funded health professionals • Curriculum shift towards greater emphasis on primary care

• Rigorous monitoring and upholding of NBB beds ratio in hospitals (90% for government, 60% for GOCC, 10% for private) • Establishment only of network-based facilities that provide comprehensive care in accordance with a national plan • 100% income retention for all government health facilities • Prescribing standard ission/discharge procedures in all health facilities

• Sparse attention to health policy and systems strengthening-oriented research • Lack of standards setting body for treatment and care provision

• Establishment of a Health Policy and Systems Research Institute • Establishment of a G clearinghouse